Healthcare Provider Details

I. General information

NPI: 1811511207
Provider Name (Legal Business Name): TAMPA BAY OPHTHALMIC PLASTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28050 US HIGHWAY 19 N STE 402
CLEARWATER FL
33761-2629
US

IV. Provider business mailing address

28050 US HIGHWAY 19 N STE 402
CLEARWATER FL
33761-2629
US

V. Phone/Fax

Practice location:
  • Phone: 727-285-8006
  • Fax: 727-216-6560
Mailing address:
  • Phone: 727-285-8006
  • Fax: 727-216-6560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KENDRA DENISE DEANGELIS
Title or Position: OWNER
Credential: MD
Phone: 727-285-8006